Seattle Weekly Interview: Mental Health System Breakdown

King County’s Involuntary Treatment Act Court has seen its cases double in the last decade and the staff can’t keep up.

“I know this is a difficult day for you, but can I ask you a few questions?” Judge Johanna Bender is asking the question while presiding over a courtroom unlike any other in King County. The subject of her inquiry is a woman strapped to a gurney. The courtroom is open to the public, but it’s intimate. There is one row of chairs in the back, but those seats are mostly occupied by attorneys. Few but court staff ever venture to the small space tucked away on the second floor of a building at Harborview Medical Center.

After responding in the affirmative, the patient is asked, “What do you like to do for fun?”

After a long silence, she responds in a quiet voice, “Crafts.”

This isn’t a criminal proceeding. This is King County’s Involuntary Treatment Act Court, where it is decided whether mentally ill patients need to be involuntarily committed to a hospital because they either pose a threat to themselves or others.

The court is the product of the Involuntary Treatment Act, which was enacted in Washington in 1974, creating these courts in every county in the state. The Act was established for patients needing court-ordered mental health treatment, the courts meant to be a last resort for the most severe cases of mental illness in our community. Since its founding, the court has operated in relative obscurity.

A recent spike in caseloads, however, has King County officials at the highest levels sounding the alarm on the ITA Court. Since 2006, the number of cases referred to the court has nearly doubled from 2,094 initial detentions in 2006 to 4,024 in 2016, a 92 percent increase. While the 18 percent increase in population in King County is likely a factor for this spike, some believe the court system itself is to blame.

“These are people who are mentally ill [and] are not getting the legal assistance that they need to get the services that they need,” said King County Councilmember Kathy Lambert, who has been an advocate of the court since joining the council in 2001.

Bill Chandler’s son is one of those people. Chandler’s son has faced different mental health challenges at different times, but he primarily suffers from psychotic breaks, says his father. To protect Chandler’s son’s privacy, we’re not sharing his name, only his story.

That story starts somewhere around 2011 when Chandler was first introduced to ITA Court after he and his son got into a violent fight.

“He doesn’t remember this. He’d defend my life with his if he were in a normal state,” Chandler told Seattle Weekly. “But I knew this time I had to do something.”

The process to civilly commit someone often begins with a call to the authorities, who then contact a Designated Mental Health Professional (DMHP), a state employee who evaluates whether or not someone should be involuntarily committed. The threshold for commitment is high. According to the Involuntary Treatment Act, a person has to threaten to harm themselves or others, substantially damage someone’s property, or be unable to take care of themselves—usually, this means they’re not sleeping or eating.

If imminent danger exists, the person will be immediately detained, picked up by an ambulance, and taken to an Evaluation and Treatment facility. In King County, the “facility” is a special bed in one of about half a dozen hospitals. Chandler says initial detainments are excruciating to watch.

“I can’t imagine it happening. People come and grab you, and you don’t know what’s going on,” said Chandler. Chandler estimates that’s happened to his son seven times, three in the past year.

After initial detention, a person is held for observation. The Involuntary Treatment Act stipulates a person can be held up to 72 hours, excluding weekends, before they must have a hearing to determine whether they will be civilly committed for another 14 days. In King County, the ITA Court is often unable to hold those hearings within that 72-hour timeline.

“I think that we have a system in crisis,” Judge Bender told Seattle Weekly from behind her desk during recess on a recent afternoon. Judge Bender has been with the court since the beginning of 2017.

The court calls these delayed cases “bubble cases.” They occur when both the hospital and the patient are ready for a hearing but because of time constraints the hearing doesn’t happen. In 2014, there were 113 “bubble cases.” So far in 2017, there have been 935, an eightfold increase and the year isn’t even over.

These numbers include cases mentioned above, where a patient has a right to a hearing in 72 hours but also includes civil commitment extension hearings where the court has more time, 30 days, to hold a hearing.

“People are being detained an extra day because of bubbling, and that is terrible,” said Anita Khandelwal, policy director for the Department of Public Defense.

For the patients, this means another day confined in a hospital, another day without freedom. But for the families, too, it can cause difficulty.

“You take a day off work. You drive in there. It’s frustrating,” said Chandler about his experience showing up to testify for a scheduled hearing, only to be turned away. “But it’s sort of okay because then he’s not going to get released and I get to sleep for another day, and he’s safe for another day.”

To Chandler, the real problem is that ITA Court is ineffective. He calls the court a “waste” and “a complete mess.”

Chandler says the court has had three outcomes for his son. One, a hearing is held and a judge decides to civilly commit his son for 14 or in some cases 90 days. But during that commitment a deal is made called a “least restrictive order,” allowing his son to be released as long as he promises to meet certain conditions like taking his medication.

“Then he doesn’t take his meds, and we’re right back where we were, except he doesn’t trust anybody,” said Chandler.

The second outcome is that a civil commitment hearing is held but by that time his son is medicated. The judge determines that he’s fine and releases him. But to Chandler this isn’t a solution; his son is only temporarily well.

Chandler says the other outcome is even worse. He says that’s when you never get a hearing in ITA Court at all. A person is detained, but for whatever reason, the case is dismissed and the person is released.

According to the court, those types of situations accounted for a quarter of the initial detentions in 2012. But that number is rising. Last year, one-third of cases were dismissed before a hearing. Chandler says this statistic shows the court is not taking initial detentions and the recommendations of DMHPs seriously.

“These people [DMHPs] are determining whether these people are a danger to themselves and others and then we have a bunch of lawyers deciding they’re not,” said Chandler of the prosecuting and defense attorneys in the court. While a judge is responsible for deciding a patient’s fate, deals are often made for a patient’s release prior to a hearing.

But Ann Mizuta, the supervising prosecuting attorney in the ITA Court says sometimes not going to trial is a “win for everybody.” She argues that hearings are not desirable or therapeutic for a patient because a hearing is an adversarial process that forces family members to lay accusations against their loved ones in public.

But to Chandler “every one of those [patients] is going to be back, so that’s not any kind of victory. That’s a disaster.” Chandler says that in his experience the ITA Court process doesn’t treat the problem; it just runs the patients through the system over and over again.

“You’re asking me what I make of all that, and the answer is, ‘I’m not sure,’ ” said Judge Bender. “One reasonable conclusion is that we don’t have the resources that we need to attend to this body of work in an intentional and timely way.”

The one area that appears overtaxed to some officials is the prosecuting arm of the ITA Court.

“We want to have the resources to make sure their case can be heard,” said prosecuting attorney supervisor Mizuta. “It is a priority for everyone to get [their cases heard], but that does not always happen.”

Currently, there are five full-time and one part-time prosecuting trial attorneys in ITA Court. According to Mizuta, those attorneys handle 15 cases a day. Compare that to the 18 public defenders working in the court who handle 25 to 30 cases per month.

While the disparity seems stark, no one, not even the court’s prosecuting attorney’s office, is advocating for an equal ratio. The main reason for this is the nature of the public defenders’ work. Department of Public Defense attorneys must travel to area hospitals to speak with their clients. Additionally, after media pressure in 2012, the Washington State Supreme Court adopted new “Indigent Defense Standards” that limit the number of cases public defenders can take in any given year. In the case of the civil commitments, that limit is 250 annually, a number defense attorneys in ITA Court exceed consistently, according to the Department of Public Defense.

Still, the workload of prosecuting attorneys recently caught the attention of County Councilmember Lambert. Last month she introduced an amendment to the supplemental county budget to fund two more full-time ITA Court prosecuting attorneys.

“The problem is only going to get worse guys, and this is the tip of the iceberg, and I’m trying to get ahead of the iceberg so that it doesn’t hurt people that are mentally ill,” Lambert said at a King County Council meeting in early November. The King County Council unanimously approved the additional spending to add two prosecuting attorneys to ITA Court at an annual cost of $204,000. The Prosecuting Attorney’s Office will be allocated that money next month, but it’s unclear when these additional attorneys will be hired and ready to work.

“I think that actually this is something that we have been needing for quite a while and it will definitely help,” said Mizuta, but she admits the funding is a band-aid, not the solution to all the court’s problems.

That’s because money allocated for the new attorneys does not come from the budget for the Prosecuting Attorney’s Office but rather from the King County’s Behavioral Health and Recovery Division, which provides treatment for low-income residents with mental health and substance abuse issues.

“We’ve been very cautious to not want to use that money unnecessarily for legal purposes when patients in the community could really use this for treatment,” said Mizuta.

To Chandler “there’s not a budget problem here at all” because the court is a “joke” that doesn’t help the people it serves. Chandler said while he doesn’t know every family that goes through ITA Court, in his mental health support groups, the opinion is universal that the court system “is the worst.”

Chandler said he’s often called by families with a mentally ill relative seeking advice about the ITA Court system. His advice to them: “if you’re in danger, call the police, but don’t [call the authorities] otherwise because you’re just going to end up with a mess and it’s not going to do you any good.”

The Department of Public Defense would not comment on the recent funding allocation for more prosecuting attorneys, though policy director Khandelwal did say that her department does not want “to see more resources put in the court superstructure,” including the Department of Public Defense. Her department would rather see money put towards mental health treatment services like therapy and support groups to treat the root of the overall local mental health crisis. Khandelwal said the goal is not just to fix the court, but to treat the mentally ill and facilitate recovery, so there are fewer involuntary commitments in the first place.

“We have created an emergency situation by failing to do anything at the onset,” said Khandelwal. “It impacts the people, the clients who are forced into the system. It impacts their families that are forced to watch them suffer, and ultimately it impacts us as a community because we’re spending all this money in a system that is just not that effective and we could be spending our money more wisely and having better outcomes for folks.”

“It’s a first step,” said Judge Bender in reaction to the recent allocation of money by the King County Council.

Judge Bender advocated for the funding of the new prosecuting attorneys by testifying in front of the King County Council earlier this month. She has also convened a committee of King County leaders to analyze the problems plaguing ITA Court. The group includes the prosecuting attorney, the public defender, staff from the Department of King County Behavioral Health, as well as staff from the county executive’s office. At this point, the advisory group is relatively informal. They have no set plans to offer recommendations. Their purpose right now is to continue the discussion.

“The reality is we have created a system where we can’t do our best for these patients, and I find that very concerning,” said Judge Bender. That said, Judge Bender is quick to defend the quality of the staff working in ITA Court. “I do not say that to levy any criticism at all towards any of the attorneys who are working just admirably hard.”

Attorneys on both sides agree it’s not the quality of the staff but the system that’s broken.

“At the core, we have a shared caring for these individuals being forced into this system, but right now are not serving them in a meaningful way,” said Khandelwal.

Chandler agrees that compassion exists, from initial detentions to release, among King County sheriff’s deputies, DMHPs, and court staff, but that doesn’t change his opinion that ITA Court itself is deeply flawed.

“[The court] wrecks all sorts of lives: mine, his mother’s, his siblings’, his friends,” said Chandler. “It’s darkening. I thought we had a benevolent society.”

As for Chandler’s son, at the time of the interview he was in jail for missing a meeting the court demanded. Chandler said he believes that if his son would have received beneficial treatment just one of the seven times he visited ITA Court, he wouldn’t be behind bars right now.

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